Department of Orthopaedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland.
NDORMs, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.
Bone Joint J. 2018 Jul;100-B(7):966-972. doi: 10.1302/0301-620X.100B7.BJJ-2018-0052.R1.
This study aimed to investigate the role of quantitative histological analysis in the diagnosis of fracture-related infection (FRI).
The clinical features, microbiology culture results, and histological analysis in 156 surgically treated nonunions were used to stratify the likelihood of associated infection. There were 64 confirmed infected nonunions (one or more confirmatory criteria: pus, sinus, and bacterial growth in two or more samples), 66 aseptic nonunions (no confirmatory criteria), and 26 possibly infected nonunions (pathogen identified from a single specimen and no confirmatory criteria). The histological inflammatory response was assessed by average neutrophil polymorph (NPs) counts per high-power field (HPF) and compared with the established diagnosis.
Assuming a cut-off of over five neutrophils per high-power field to diagnose septic nonunion, there was 80% sensitivity and 100% specificity (accuracy 90%). Using a cut-off of no neutrophils seen in any high-power field to diagnose aseptic nonunion, there was a sensitivity of 85% and a specificity of 98% (accuracy 92%).
Histology can be used in a bimodal fashion as a diagnostic test for FRI. The presence of more than five NPs/HPF had a positive predictive value for infected nonunion of 100%, while the complete absence of any NPs is almost always indicative of an aseptic nonunion (positive predictive value of 98%). Cite this article: Bone Joint J 2018;100-B:966-72.
本研究旨在探讨定量组织学分析在骨折相关感染（FRI）诊断中的作用。
对 156 例经手术治疗的骨不连患者的临床特征、微生物培养结果和组织学分析进行了分层，以确定其感染的可能性。其中 64 例确诊为感染性骨不连（一个或多个确诊标准：脓液、窦道和两个或更多样本中细菌生长），66 例无菌性骨不连（无确诊标准），26 例可能感染性骨不连（从单一标本中发现病原体且无确诊标准）。通过每高倍镜视野（HPF）的平均中性粒细胞多形核（NPs）计数评估组织学炎症反应，并与既定诊断进行比较。
假设超过五个中性粒细胞/高倍视野可诊断为感染性骨不连，其敏感性为 80%，特异性为 100%（准确性为 90%）。使用未在任何高倍视野中看到任何中性粒细胞来诊断无菌性骨不连的截止值，其敏感性为 85%，特异性为 98%（准确性为 92%）。
组织学可以以双模态方式用作 FRI 的诊断测试。每高倍视野中存在超过五个 NPs 对感染性骨不连的阳性预测值为 100%，而完全不存在任何 NPs 几乎总是提示无菌性骨不连（阳性预测值为 98%）。
Bone Joint J 2018;100-B:966-72.
